Man Boob Reduction (Gynaecomastia)

There are a variety of causes for this condition, some of which are treatable medically rather than surgically. Mostly the cause is unknown, but this is a diagnosis we reach by excluding all the others which can be classified as follows:

• Changes in hormone levels after birth, at puberty and later in lie
• Various drugs:

•  cannabis
•  digoxin spironolactone and other drugs that mimic oestrogens
•  Methyldopa, phenothiazines and other drugs that raise prolactin levels.
•  Cimetidine, cyproterone acetate and drugs that inhibit testosterone.
•  gonadotrophins

• Liver disease: cirrhosis or hepatitis
• Testicular diseases:

•  Primary testicular failure: Anorchia; Klinefelter’s Syndrome; Bilateral Cryptorchidism
•  acquired testicular failure: mumps; irradiation.
•  secondary testicular failure: Hypopituitarism; isolated gonadotrophin deficiency

• Endocrine (hormonal) diseases:

•  pituitary failure
•  thyroid disease

• Growths in the:

•  testicles
•  breasts
•  adrenal glands
•  and rarely in the lungs; liver or kidneys

Usually, you will have been referred to me by your GP after undergoing an assessment to exclude the above conditions – meaning the cause for your gynaecomastia is unknown and surgery is indicated to rid you of your problem.

It is best, therefore, to have seen your GP before seeking a surgical referral, otherwise I shall have to order these tests myself which will delay your treatment and incur additional needless expense.

This is best decided during a consultation, but in general if you are a healthy, emotionally stable man, with firm, elastic skin that will contract to your chest’s new contours after breast reduction, you will benefit from either liposuction or surgery to decrease your breast mounds.

Obese men will gain some benefit, especially if they realise that this may help them overcome mechanical problems if their breasts get in the way during exercise, or manual work, or make it difficult to get clothing that fits. However, it must be understood that this is not an operation to correct obesity and that it will almost certainly need to be repeated if it is performed before you have reached and maintained your goal weight for 6 months.

Patients who continue to use cannabis or take any of the drugs listed above will have poor results from surgery and risk their gynaecomastia returning over time.

During your consultation, I will take a full medical history. I will ask you specifically about any conditions and drugs listed above. I will examine you completely, and then focus on your breasts to assess their size, composition, and the quality of their skin envelope. I will also take photographic views for your medical records. Depending on my findings, I may ask your GP to perform further tests, or if you prefer, order them myself at your expense.

The aim of either liposuction, or surgery for this condition is to produce as predictable, stable, and aesthetic a breast shape for you as possible.

Liposuction is best suited to small breast mounds composed mostly of fatty tissue in men with good elastic skin tone. It involves making 2 – 3 small incisions through which the excess tissue is sucked out.

Surgical technique depends on the size of your breast mounds and the elastic tone of your skin. At the least, incisions are made around half the circumference of the areolar skin, but may stretch all the way around the areolar, then vertically down the chest wall and then in a symmetrical curve below – to leave an anchor-shaped scar.

Before surgery, you will be assessed by your anaesthetist who will prescribe medications for your comfort and to lessen anxiety if needed.
On the evening prior or the morning of your operation I will review what we have discussed, and we will both sign your operation consent forms. I will then measure and draw guidance marks for surgery on your chest and breasts.

The operation usually takes an hour or so and is performed under General Anaesthetic so you will be asleep. After surgery, you will awake in a recovery area and soon afterwards be taken to your room.

A drain is placed under the incision in each breast to remove normal healing fluid. These are usually removed after a day or two and you can then shower normally.

Most patients go home a day or two after surgery on simple pain-relieving medications and a short course of antibiotics.

You will feel tired and somewhat sore for a week or two following your surgery, but you will be able to move around and function relatively normally. There are no stitches to remove as these will dissolve.

You will be swollen and bruised after surgery or liposuction, and this can influence your healing and final result, so to counter this you will need to wear an elastic pressure garment 24 hours a day, 7 days a week, for 4 weeks after surgery – except when you are washing you or it! Thereafter, you should wear it at night for a further 4 weeks. Your final result will mature over 3 – 6 months.

I encourage you to start gentle exercise immediately. You can return to work as soon as you feel able, but if your work involves heavy, manual work, you should have at least a week off, or on lighter duties.

New scars benefit from friction-free massage (using Vaseline, for instance, to lubricate the massaging process). Beginning to massage scars two to three weeks after surgery, will help them mature, soften and flatten faster than if left to their own devices. New scars should be protected from sunlight for 2 years to avoid them pigmenting differently from the surrounding skin and becoming a different colour permanently. Factor 15 sun block should be applied whenever they are exposed – even to a British winter sun.

In the longer term, final size, shape, symmetry, and aesthetic result of breasts after reduction surgery will vary according to individual factors. If asymmetry is significant, a second procedure may be performed to remove additional tissue.

You may find you lose nipple sensation, which although usually a temporary loss, may take up to a year to return, and may remain permanently diminished or absent.

You may also experience altered pigmentation in the nipple-areolar skin, which may be permanent.